Current Trends
Mortality Patterns -- United States

Based on death certificate information compiled by CDC's
National Center for Health Statistics (NCHS) (1), 2,123,323
deaths were registered in the United States in 1987. This is
17,962 more deaths than in 1986 and the largest annual final
number ever recorded. In 1987, nearly three fourths of deaths
were caused by the first four leading causes of death--heart
disease, cancer, stroke, and unintentional injuries. This report
summarizes mortality data compiled by NCHS for 1987 (1).

Despite the increase in the number of deaths, the overall
age-adjusted death rate* for 1987 declined to a record low of
535.5 per 100,000 population--or approximately 1.0% lower than in
1986 (541.7). From 1986 to 1987, rates declined for 13 of the 15
leading causes of death (Table 1). The rate for heart disease,
the greatest contributor to U.S. mortality, declined by 3.1%. The
rate for cancer declined for the second consecutive year, in
contrast to the general increase since 1950. Mortality from
homicide decreased by 4.4%, the largest decline among the 15
leading causes of death. From 1986 to 1987, the ranking of the
leading causes of death remained unchanged with the exception of
congenital anomalies, which was replaced as the 15th leading
cause of death by human immunodeficiency virus (HIV) infection.

In 1987, age-adjusted death rates for men were higher than
those for women (Table 2). The greatest sex differential in
mortality was for HIV infection, for which the rate for males was
9.1 times that for females. The rate for unintentional injuries
(International Classification of Diseases, Ninth Revision (ICD-9)
"accidents and adverse effects"** (rubrics E800-E949) (2)) was
2.7 times higher for males than for females. The smallest
difference between the sexes was for diabetes mellitus
(male/female ratio=1.1:1).

When compared with 1986, age-adjusted death rates declined for
white persons*** (from 518.0 to 511.1) and remained essentially
unchanged for black persons (from 781.0 to 778.6). The largest
difference between rates was for homicide, with the rate for
blacks 6.0 times that for whites (Table 2). Of the 15 leading
causes of death, two--suicide and chronic obstructive pulmonary
disease and allied conditions--had lower death rates for blacks
than for whites.

In 1987, HIV infection accounted for 13,468 deaths. Of these,
8700 (64.6%) were in white males, 3301 (24.5%) in black males,
739 (5.5%) in black females, and 628 (4.7%) in white females.
Most (72.9%) HIV-associated deaths occurred in persons aged 25-44
years. Age-adjusted death rates were highest for black males
(25.4), followed by white males (8.3), black females (4.7), and
white females (0.6). Age-specific death rates followed a similar
pattern.

In 1987, overall life expectancy at birth reached an all-time
high of 75 years, increasing to 75.6 years for whites and
remaining stable (69.4 years) for blacks. The difference in life
expectancy between whites and blacks narrowed from 7.6 years in
1970 to 5.6 years in 1984, then increased to 6.2 years from 1984
to 1987. The difference in life expectancy between the sexes,
which widened from 1900 to 1972, narrowed after 1979. Women are
still expected to outlive men by an average of 6.9 years.
Reported by: Div of Vital Statistics, National Center for Health
Statistics; Div of Surveillance and Epidemiologic Studies,
Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Death rates are usually based on the underlying
cause of death, defined by the ICD-9 as "(a) the disease or
injury which initiated the train of morbid events leading
directly to death, or (b) the circumstances of the accident or
violence which produced the fatal injury" (2). During a time when
the age distribution is changing, age-adjusted death rates
indicate more effectively than crude death rates changes in the
risk of death. In addition, age-adjusted rates are better
indicators for comparisons of mortality by sex or racial
subgroup.

Factors that contributed to the increased number of deaths in
1987 included population growth and the aging of the U.S.
population (i.e., the increasing proportion of older persons).
Beginning with data for 1987, the ICD-9 was supplemented by new
categories for coding HIV infection and acquired immunodeficiency
syndrome (AIDS) (042-044) (3). Before 1987, many HIV-associated
deaths were assigned codes for deficiency of cell-mediated
immunity (ICD-9 279.1) (adapted for HIV/AIDS in 1983-1986),
Pneumocystis carinii pneumonia (ICD-9 136.3), and other
conditions. The national surveillance of AIDS cases reported a
32% increase in deaths from 1986 to 1987 (CDC, unpublished data).
Although part of this increase may be due to modification of the
AIDS case definition in 1987 (4), mortality from AIDS appears to
be increasing more rapidly than mortality from other conditions.

World Health Organization. Manual of the international
statistical classification of diseases, injuries, and causes of
death--based on the recommendations of the Ninth Revision
Conference, 1975. Geneva: World Health Organization, 1977.

CDC. Revision of the CDC surveillance case definition for
acquired immunodeficiency syndrome. MMWR 1987;36(no. 1S).
*Age-adjusted to the 1940 U.S. population.
**When a death occurs under "accidental" circumstances, the
preferred term within the public health community is
"unintentional injury."
***Hispanics are included in totals for both white persons and
black persons.

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